The giant juggernaut that is healthcare in the US (from 2009)

Today’s ACA ruling by the Supreme Court puts into place healthcare legislation that was crafted by the Heritage Foundation and championed by conservatives back in 1993 (round up of links on ruling over at Shakesville).

It’s not perfect. At all. Long way to go, in fact. But whenever I feel despair regarding the long haul, I think back to a brilliant piece that Atul Gawande wrote in 2009:

From The New Yorker (bolded emphasis is mine)

Yes, American health care is an appallingly patched-together ship, with rotting timbers, water leaking in, mercenaries on board, and fifteen per cent of the passengers thrown over the rails just to keep it afloat. But hundreds of millions of people depend on it. The system provides more than thirty-five million hospital stays a year, sixty-four million surgical procedures, nine hundred million office visits, three and a half billion prescriptions. It represents a sixth of our economy. There is no dry-docking health care for a few months, or even for an afternoon, while we rebuild it. Grand plans admit no possibility of mistakes or failures, or the chance to learn from them. If we get things wrong, people will die. This doesn’t mean that ambitious reform is beyond us. But we have to start with what we have.


But we can build a new system on the old one. On the start date for our new health-care system—on, say, January 1, 2011—there need be no noticeable change for the vast majority of Americans who have dependable coverage and decent health care. But we can construct a kind of lifeboat alongside it for those who have been left out or dumped out, a rescue program for people like Starla Darling.

In designing this program, we’ll inevitably want to build on the institutions we already have. That precept sounds as if it would severely limit our choices. But our health-care system has been a hodgepodge for so long that we actually have experience with all kinds of systems. The truth is that American health care has been more flotilla than ship. Our veterans’ health-care system is a program of twelve hundred government-run hospitals and other medical facilities all across the country (just like Britain’s). We could open it up to other people. We could give people a chance to join Medicare, our government insurance program (much like Canada’s). Or we could provide people with coverage through the benefits program that federal workers already have, a system of private-insurance choices (like Switzerland’s).


It will be no utopia. People will still face co-payments and premiums. There may still be agonizing disputes over coverage for non-standard treatments. Whatever the system’s contours, we will still find it exasperating, even disappointing. We’re not going to get perfection. But we can have transformation—which is to say, a health-care system that works. And there are ways to get there that start from where we are.


One thought on “The giant juggernaut that is healthcare in the US (from 2009)

  1. What a tragic day in the history of democracy when the Supreme Court of the United States affirms that it is OK for the federal government to require that a citizen buy a product and then to declare the fine for not doing so a tax. The end does not always justify the means as is certainly true in this case. Well, at least now it’s not just women who have had the freedom of choice stripped away.

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